What to do When Back Surgery Fails to Relieve the Pain
Updated: Aug 19, 2021
Failed back surgery syndrome is a pervasive, painful condition, but patients are finding relief with modern, minimally invasive treatments.
More than 80 percent of all Americans will experience back pain at some point in their lives, leading to more than 14 million doctor’s visits every year, making back or neck pain the second most common reason people see a doctor.
Most of these people find relief in a few months, through proper medical treatment and simple at-home remedies. But, for one-in-ten Americans with back pain, these remedies offer little to no relief. The pain continues, becoming recurrent or chronic, often growing worse over time. Which is one reason why lower back pain is the leading cause of disability in the world.
Trying to regain quality of life leads some people suffering with lower back pain to elect a highly-invasive surgical procedure called spinal fusion surgery. For some patients, fusion surgery is a solution to their pain, for many others, fusion surgery is all risk and no reward. In fact, some reports indicate that up to 40 percent of patients who undergo spinal fusion surgery are dissatisfied with the results. Think about that: these people are in so much pain, they opt to permanently fuse part of their spine together—risking nerve damage, infection, blood clots, and other negative outcomes—and they still have recurring or chronic pain. This is one of the primary symptoms of Failed Back Surgery Syndrome (FBSS).
What is Failed Back Surgery Syndrome?
Also known as “Postlumbar laminectomy syndrome,” failed back surgery syndrome encompasses a number of surgical outcomes considered suboptimal, including persistent or chronic pain and compromised functionality. Some patients feel better initially, but the pain returns as they heal from surgery. For others, the pain never goes away. By many estimates, this condition affects nearly 80,000 people per year.
Metrics used to measure the success of back surgery include pain reduction or elimination, improved functionality, and better quality of life. While the name “failed back syndrome” implies the procedure itself was a “failure,” this is not necessarily the case. The attending physician may do everything in their power, following every protocol exactly as they should, and the surgery may still be a “failure,” because the patient is not experiencing long-term positive results.
One of the most difficult factors for a patient living with failed back surgery syndrome, is that further surgery is often not the best option. This is because the spinal fusion surgery success rate decreases significantly with each subsequent surgery.
Causes of Failed Back Syndrome
Patients experiencing failed back syndrome often describe dull, aching pain in the back or legs, as well as sharp, stabbing pain in the extremities. These issues could be the result of or exacerbated by: Spinal disc herniation, pressure on the spinal nerve, reduced joint mobility or joint instability, fibrosis, and muscular deconditioning. Two of the most common causes of failed back surgery syndrome include Pseudarthrosis (non-union) and continued degeneration.
Pseudarthrosis describes a condition in which a solid spinal fusion fails to form. This becomes apparent only over time, because fusion is a process that occurs after surgery. During surgery, the spine is stabilized, however the bones take time to grow together, similar to how a broken bone heals. For some people, this fusion simply never happens, leading to recurrent or chronic pain.
Continued degeneration describes progressive damage to the vertebrae and disks on either side of the fused vertebrae, causing new or continual wear and tear. This can happen even when surgery is successful and fusion occurs.
Treating Failed Back Syndrome
Along with stretching and low-impact exercise to rebuild core strength, some initial treatment options for failed back surgery syndrome may include non-steroidal anti-inflammatory medication (NSAIDs), nerve blocks, injections, or radiofrequency ablation. If these treatments are ineffective, the attending physician may recommend spinal cord stimulation.
SCS: Proven Treatment for Failed Back Syndrome
Spinal cord stimulation (SCS) blocks or disrupts pain signals before they reach the brain, so chronic pain is replaced, reduced, or eliminated. This method has been successfully used to treat FBSS for more than 40 years. We’ve seen excellent results in my practice, and we’re not alone. According to studies conducted by the Congress of Neurological Surgeons, “SCS can provide a good outcome in the treatment of FBSS,” … nearly 9 out of 10 patients reported satisfactory outcomes.
While spinal cord stimulation is a proven long-term solution to chronic pain caused by failed back surgery syndrome, patients have the opportunity to try SCS on a temporary basis before committing to the more permanent treatment. With both the test version and the permanent version, the patient maintains personal control of the intensity of the pain-relieving stimulation.
To learn more about back pain treatments, including Spinal Cord Stimulation, click here to schedule an appointment or to Read Dr. Skaliy’s FREE eBook about Spinal Cord Stimulation visit our Pain Relief Section of our website, www.atlantaspinespecialists.com.